Objective. To determine diagnostic and prognostic significance of high-sensitivity Creactive protein (hsCRP) in systemic sclerosis (SS), to define relationship of this factor with activity of the disease and cardiovascular pathology, to assess role of pro-inflammatory cytokines in induction of acute phase proteins synthesis in SS.

Material and methods. Serum levels of hsCRP, interleukin (IL) 6, IL 1β, IL1ra, IL 10, sIL2r were evaluated by enzyme immunoassay (EIA) in 40 pts with SS and 24 subjects of control group. Relationship with clinical features of the disease, endothelial dysfunction, capillaries structure changes, sub-clinical atherosclerosis, total coronary risk and some traditional cardiovascular risk factors was analyzed. Instrumental assessment included nailfold capillaroscopy, sonographic duplex examination of carotids , brachial arte ry sonographic examination. HsCRP prognostic significance was assessed in 51 pts with SS.

Results. Elevated levels of hsCRP were found in 32% of SS pts and correlated with activity and severity of the disease, HAQ and SHAQ. Direct correlation of hsCRP with skin fibrosis distribution, interstitial lung disease, arthritis, laboratory indices of SS activity (ESR, sIL2r) and Scl-70 was revealed. HsCRP concentration in SS did not depend on character and intensity of cardiovascular pathology, subclinical atherosclerosis, endothelial dysfunction and proinflammatory cytokines production.

Conclusion. HsCRP in SS reflects intensity of immuno-inflammatory process, correlates with T-cell activation markers and can be used as index of the disease activity, severity of skin and lung fibrosis.

Objective. To reveal clinico-laboratory, immunologic and immunogenetic features of systemic sclerosis-rheumatoid arthritis overlap syndrome (SS-RA).

Material and methods. 32 pts with SS-RA (1 male, 31 female) aged 22 to 74 years with disease onset at 18 to 69 years and disease duration from 1 to 35 years were included. Complex laboratory and instrumental examination was performed including nailfold capillaroscopy. A part of pts was also evaluated with magnetic resonance imaging of hands. Serum level of rheumatoid factor, antinuclear factor, circulating immune complexes, C-reactive protein, antibodies to cyclic citrullinated peptide (ACCP) was evaluated. Genotyping of DRB1 alleles was performed.

Results. Characteristic features of SS-RA were prevalence of limited skin damage, less prominent peripheral and visceral symptoms of SS, presence of anti-topoisomerase antibodies and erosive arthritis, high laboratory and immunological activity, more frequent association with DRB1*01.

Conclusion. SS-RA possesses its own clinical features and can be considered as a distinct subtype of SS.

Objective. To assess frequency of traditional cardiovascular risk factors, clinical and subclinical atherosclerosis features in patients with systemic sclerosis (SS).

Material and methods. 70 pts with definite diagnosis of SS ( 66 female and 4 male with mean age 46±10,8 years) were included. Control group consisted of 50 relatively healthy volunteers without systemic rheumatic diseases and Raynaud’s phenomenon, matched on sex and age. Classic risk factors of atherosclerosis were analyzed. Total coronary risk (TCR) (10-years risk of cardiovascular catastrophes development) was assessed with Framingham scale. Carotid sonographic examination with intima-media complex thickness (IMT) measurement using a 7.5 MHz frequency linear transducer was performed in 60 SS pts and 45 volunteers with Voluson 730 Expert apparatus (Austria).

Results. Frequency of traditional cardiovascular risk factors and TCR was comparable in in SS pts and control. Menopause was more frequent in SS pts (p=0,005). Coronary heart disease was more frequent SS pts (13% versus 2%, p<0,05). Mean triglyceride level in SS pts was significantly higher than in the control group (p<0,001). There was a tendency to increase of IMTmax and IMT thickening in SS compared with control group. Atherosclerotic plaques were present in 10% of SS pts and were absent in control group. IMTmean and IMTmax positively correlated with age of SS pts (p<0,001; p<0,001) and TCR (p<0,001, p=0,001). IMTmean correlated with disease duration (p<0,05) and cholesterol level (p<0,05) in SS pts.

Conclusion. Frequency of clinical and subclinical atherosclerosis features in SS pts was higher than in the control group but frequency of main cardiovascular risk factors did not significantly differ. It is possible that generalized SS angiopathy predisposes to vascular atherosclerosis development in SS pts.

Objective. To assess change of annexin-5 antibodies (AA5) level and AA5 influence on gestation outcome in pregnant women with systemic lupus erythematosus (SLE).

Material and methods. 15 pregnant women with SLE who fulfilled 1997 ACR criteria (4 of them with concomitant antiphospholipid syndrome – APS) were included. Median age of pts was 28,0 (23- 33) years, median SLE duration – 4,0 (3-9) years. SLEDAI activity score at the beginning of gestation was 2 (2-11). All but one pts received metypred from 2 to 20 mg/day. The women were examined in every trimester of gestation. AA5 and anticardiolipine antibodies (ACLA) were evaluated with immunoenzyme assay.

Results. AA5 elevation was revealed in 7 women (group 1): 6 of them were only IgG AA5 positive, 1 had both IgG and IgM AA5. Isolated IgM AA5 elevation was absent. 4 pts had borderline IgG AA5 values (from 5,3 to 7,4 U/ml). 3 pts had respectively 9,6, 12,1 and 168,5 U/ml. The last pt was also positive for IgM AA5 (till 14,4 U/ml). AA5 elevation was more frequent and more prominent during the II trimester of gestation. 8 pts with SLE (group 2) did not have AA5 elevation. 11 from 15 gestations ended with birth of viable baby, the rest 4 had unfavorable outcome. Median terms of delivery did not differ in both groups and came to 36 weeks. 3 pts with normal AA5 and 1 pt with elevated AA5 had gestation lost. 3 from these 4 pts were ACLA positive and APS was earlier diagnosed in 2 from them.

Conclusion. Almost half of pregnant women with SLE (7 from 15) had AA5 elevation mainly during the II trimester of gestation. Unfavorable gestation outcomes were not associated with AA5 elevation. Possibly low levels of AA5 positivity and small sample size could influence the results.

Objective. To study clinical picture and significance of diagnostic criteria of polymyalgia rheumatica (PMR) in pts of Habarovsk region.

Material and methods. 76 pts (63 female, 13 male) fulfilled modified PMR diagnostic criteria (h. Bird 1997, 2001) were included. Mean age of the patients at the diagnosis was 66,2±1,0 years. Frequency and intensity of myalgia and joint syndrome, laboratory changes, and efficacy of corticosteroid (CS) low doses were evaluated.

Results. Annually 4-9 new cases of PRM were revealed in Habarovsk region. Mean duration of the disease before the diagnosis was 7,5±1,0 months. 69 pts (86,3%) had typical disease onset with cervical, shoulder, pelvic muscles involvement. In 11 pts (13,7%) joint syndrome was the presenting feature and in 3 pts the disease onset resembled McCarty disease. Knee and wrist joints were involved most frequently (43,8% and 25,0% respectively). Giant cell arteritis (Horton disease) developed in 5,3% of cases. ESR exceeded 30 mm/hour in 68 pts (89,5%). In 8 pts (10,5%) ESR remained in normal limits. CS test in 3 pts (3,9%) provided positive result after the first several hours, in 6 pts (7,9%) – during the first day, in 59 pts (77,7%) – after 3 days and in 8 pts (10,5%) – to the end of the week.

Conclusion. PMR course in the Far East residents did not differ from classical picture. CS low doses administration is an important test for PMR diagnosis.

Objective. To assess clinical and diagnostic value of antibodies to nucleosom e in «early» systemic lupus erythematosus (SLE).

Material and methods. 37 pts with «early « SLE were included. The control groups consisted of 36 pts with rheumatoid arthritis (RA), 31 pts with primary Sjogren›s syndrom e (SS) and 45 healthy subjects. Concentration of antibodies to nucleosom e and to double stranded deoxyribonucleic acid (dsDNA) was measured with enzyme immunoassay (EIA).

Results. The level of antinucleosom e antibodies in SLE pts (64,5 ± 53,7 U/ml) was significantly higher than in RA and SS pts (JO, 9 ±23,7 U/ml; p<0,05 и 15,7 ±11,5 U/ml respectively; p<0,05) or in donors (8,3 ± 5,2 U/ml; p<0,05). Correlation was found between level of antibodies to nucleosom e and antibodies to dsDNA (χ2 = 14,4; p<0,05). Sensitivity (87,5%) and specificity (95%) of antinucleosom e antibodies were similar to anti-dsDNA antibodies (85,2% и 93% respectively). Simultaneous evaluation of antibodies to nucleosom e and dsDNA provided 97 % specificity. There was a correlation between the level of antibodies to nucleosom e and disease activity in SLE (p<0,0001).

Conclusion. Evaluation of antinucleosom e antibodies with EIA is a sensitive and specific serological test for early SLE diagnosis. The antibodies to nucleosom e reflect activity of SLE

Objective. To assess efficacy of hyperuricemia and other metabolic syndrome (MS) features treatment with siofor in patients with gout in hospital.

Material and methods. 50 male pts with gout (mean age 54,5±2,0 years) were included. Diagnosis of gout fulfilled recommendations of S. Wallace et al [14]. MS was diagnosed according to common criteria. All pts were examined at admission and after completion of hospital treatment. Height, weight, waist and thighs circumference, skin fold thickness above triceps muscle and blood pressure were measured. Body mass index, waist circumference/thighs circumference (WC/TC) index were counted. Uric acid (UA), triglycerides, cholesterol, glucose, creatinine and urea blood concentration was evaluated. 13 pts without contraindications and anti-gout therapy were treated with siofor.

Results. Hyperuricemia was present in 72,9% of gout pts with MS. UA concentration correlated with somatic and laboratory features of MS. Hospital treatment with siofor provided significant decrease of UA concentration and tendency to decrease triglycerides and cholesterol. Somatometric features of MS did not change.

Conclusion. Administration of siofor in hospital is a necessary initial stage of long term gout therapy with medications decreasing insulin resistance. This stage should include choice of effective dose of the drug, assessment of its tolerability, evaluation of possibility of other
MS features correction.

Objective. To assess efficacy and tolerability of infliximab in pts with rheumatoid arthritis (RA) in real clinical practice.

Materials and methods. 75 RA pts with high disease activity according to DAS 28 in 80% who received previous antirheumatic drugs without proper effect were included in an open clinical trial. DAS 28 and ACR criteria were used as primary outcome measures.

Results. Infliximab administration provided significant clinical improvement in most pts. Already in a week after the first infusion 20% ACR improvement was achieved in 74% of pts. Significant improvement of all the main treatment effect parameters was achieved after the second infusion. ESR and CRP mean values normalized after the third infusion. Rheumatoid factor decrease was noted after 6 weeks. Mean values of tender and swollen joint counts significantly decreased but arthritis signs remained in a part of pts. Clinical remission was achieved in 4 (19%) from 21 pts completed a year’s course of treatment and in 4 pts the treatment was not effective. Serious adverse events requiring infliximab withdrawal (including infectious arthritis, hand phlegmon and bronchitis) appeared in 7 pts

Conclusion. These results show high efficacy of infliximab and prove advisability of its administration in RA

Objective. To study clinical efficacy and safety of piascledine in the treatment of osteoarthritis (OA) in pts with gout.

Material and methods. 30 pts older than 35 years with gout and concomitant OA were included. During 2 months they received piascledine 300 mg/day. All pts fulfilled Wallace S. criteria for gout and ACR criteria for OA. Exclusion criteria: renal and hepatic failure,
severe infections, childbearing potential female, administration of other chondroprotectors. Clinical and laboratory examination was performed before and after 2 months of treatment with piascledine.

Results. After 2 months of treatment pain on VAS decreased at rest (p<0,01) and at movement (p<0,05). There were no adverse events leading to withdrawal of the drug. Uric acid serum level, measures of lipid and carbohydrate metabolism, renal and hepatic function did not significantly differ from baseline.

Conclusion. Piascledine administration in gout pts with OA is safe, effectively decrease pain and do not influence serum level of uric acid.

Objective. To perform a prospective investigation of clinico-laboratory and sonographic picture of juvenile arthritis (JA) onset, to follow up its evolution during the first years of the disease, to prove the program of appropriate treatment.

Material and methods. 128 pts with early JA (61% girls and 39% boys aged 1,5 to 16 years) were included. Disease duration varied from 2 weeks to 6 months. General health, joint status, disease activity, functional class (Steinbroker), systemic and organ disturbances, laboratory activity indices, immunologic parameters (ANF, RF) were assessed. Antibodies to cyclic citrullinated peptide (ACCP) were evaluated in 38 pts by immunofluorescence method (IFM) with commercial kits “Axis Shild Diagnostics Limited, UK”, antibodies to modified citrullinated vimentin (MCV) were assessed in 60 pts by IFM with commercial kits “Orgentec” (Germany). Pts were examined every 3 months, the main investigations were repeated after 6, 12 and 24 months. Accuracy of the diagnosis was checked at every examination.

Results. Mono- oligoarticular variant of onset was found in 68,6% polyarticular – in 21,4%, systemic – in 10% of pts. Knee and ankle joints were involved first (61% and 24% respectively), later – wrist (13%) and hand joints (17%). Morning stiffness was absent in 85% of pts. 37% of pts had ANF and 13,2% - RF. 10,5% were ACCP positive and 28,3% – MCV positive. Antibodies correlated with polyarticular variant of JA and RF. Reactive arthritis was the preliminary diagnosis in 39% and JRA – in 21% of pts at inclusion. Later Juvenile chronic arthritis was the most frequent diagnosis (73-80%). Disease modifying antirheumatic drugs were prescribed early (before 6 months) in 53% of pts. Exacerbations of the disease appeared in 1/3 of pts, more frequently – in pts with polyarthritis. After 12 months functional class 1 remained in 71,4% of pts.

Conclusion. Stabilization of pathological process or remission can be achieved in most children with early JA. Pts with polyarthritis sometimes need intensification of treatment (administration of biological agents or change of DMARD. Evaluation of ACCP and MCV can be helpful for diagnosis and prognosis of the disease. Questions of diagnosis, terminology and early verification of diagnosis need further discussion.

Objective. To evaluate psychometric properties of Patient Activity Scale (PAS) index and possibility of its application for assessment of pt functional activity (PFA) and therapy efficacy in pts with rheumatoid arthritis (RA).

Material and methods. Validity assessment was performed on 454 pts with definite RA,mainly female (85,2%) with mean age 51,3±11,3 years, mean disease duration was 9,1±8,5 years, 59,7% of pts were seropositive on rheumatoid factor, most pts had moderate or high inflammatory activity of the disease (95,6%), II or III radiological stage ( 44,7% and 27,8% respectively, II (53,5%) or III (31,8%) functional class. Constructive validity of the index was assessed by calculation of coefficients of correlation with “external criteria”. Sensitivity was assessed with ACR criteria in 285 pts after 6 months of standard therapy. Reliability (reproducibility and internal constancy) were assessed in 92 pts in 3 days after admission.

Results. Assessment of PAS reliability with test-retest analysis did not reveal differences between first and repeat examination of pts whose state had not change after 3 days (mean scores 5,07±1,27 and 5,17±1,34 respectively, p=0,45). Intra-class Cronbach alpha coefficient was 0,95 (p<0,000001). Constructive validity assessment revealed moderate relationship of PFA with disease inflammatory activity measures: morning stiffness duration (r= 0,33, p<0,0000001), DAS 28 value (r=46, p<0,001), tender joint count (r=0,39, p<0,0000001), swollen joint count (r=0,28, p<0,0002) and weak relationship with ESR and radiological stage of the disease (r=0,17, p<0,00001). PAS correlation relationships with quality of life measures assessed on all SF-36 scales varied from -0,37 to -0,58. Index sensitivity to changes assessment showed that PAS change exceeding 0,22 corresponded to at least 20% health improvement according to ACR criteria.

Conclusion. PAS is a reliable, valid and sensitive instrument of pt functional state self assessment and can be used for dynamic evaluation of pts state and treatment efficacy in outpatient practice